Pediatric Pain Management and Palliative Care in Nigeria: A Scoping Review

Pain is a common experience for pediatric patients, yet it remains inadequately managed, particularly in low-resource settings. Pediatric palliative care (PPC) services are underdeveloped in many low- and middle-income countries, including Nigeria. This scoping review examines pediatric pain management (across acute, procedural, and chronic pain types in various care settings) and palliative care in Nigeria, evaluating barriers, facilitators, and implementation gaps.

A comprehensive search was conducted for literature on pediatric pain management and palliative care in Nigeria across PubMed, Scopus, African Journals Online, and Google Scholar up to December 2024. Eligible studies were screened using Rayyan QCRI (a web-based systematic review platform) and analyzed with NVivo 12 (qualitative analysis software) for qualitative synthesis. Data on healthcare provider knowledge, pain management practices, palliative care services, and patient outcomes were extracted. The review followed PRISMA-ScR guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews), with findings synthesized narratively due to study design heterogeneity.

Eleven studies met the inclusion criteria (surveys of healthcare providers, audits of practices, and one RCT). Healthcare providers exhibited poor knowledge and suboptimal practices in pediatric pain management; only 30% could name three non-pharmacological pain management methods, and 52% had never prescribed morphine. Acute pain management practices in major centres relied heavily on basic analgesics but lacked advanced modalities. Two-thirds of pediatric anesthetists reported no institutional guidelines for pediatric pain, only ~5% of surgeons used any formal pain assessment tool, and no neonates received morphine post-operatively in one survey. Pediatric palliative care services were limited, with only 10 dedicated centres serving a small fraction of children in need, and most children with life-limiting illnesses were managed in general wards without specialist palliative input. Children with life-limiting illnesses suffered significant symptom burdens, including pain-over 50% of pediatric cancer patients in one study reported pain as frequent and distressing. Caregivers of these children also experienced high psychological stress, correlating with the child's symptom burden.

Pediatric pain management and palliative care in Nigeria are in early stages. Gaps in provider training, guideline implementation, and service availability hinder progress. Strengthening education (including integration of pediatric pain/palliative care into curricula), improving opioid access (e.g., implementing national pain guidelines), and expanding dedicated palliative care services are critical to meeting the needs of children in Nigeria.